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Section D
Determinants of Adult Health and Development
Determinants of Health Disparities

Disparities reflect groups’ relative social position which leads to
inequalities in access to resources of all types

This is called structured inequality—recall the Link and Phelan
(1995) we read for the third lecture

Unequal social positions expose people to “risk of risks” and so are a
fundamental cause of disease
3
Health Trajectories

Can conceptualize health trajectories: early experiences and health
influence later experiences and health

Risks accumulate over the life course

Key issue for public health is how to deflect or alter trajectories
4
Schematic Diagram of Health Trajectories
5
Early Influences on Adult Health

The effects we’ve discussed in the fetal period, infancy, childhood,
and adolescence carry over into adulthood
6
Early Influences on Health: Direct and Mediated

Fetal development (Barker)

Childhood adversity

Health behaviors learned in adolescence

Cognitive and social development in early childhood influence
school attainment, which influences adult occupational position and
social relationships
7
Relationship between Childhood Adversity and Chronic Disease

Childhood adversity increases odds of ischemic heart disease in
adulthood
8
Smoking in Adolescence and Beyond
Content for this slide to come
9
Child Development and Educational Attainment
Content for this slide to come
10
From Cognitive Development to Chronic Disease

Picture of pathway from cognitive development to chronic disease
via adult attainment
Content for this slide to come
11
Health Influences in Adulthood

Reflect continuation of earlier trajectories (previous slide)

Include new sources and types of risk (e.g., occupational hazards,
demands from social network)

May be exogenous (sudden job loss, natural disaster, displacement)
12
Two Key Domains of Adult Life
1.  Work
2.  Family life
13
Work Conditions and Cardiovascular Disease
Content for this slide to come
14
Marriage and Health
Content for this slide to come
15
Final Points

Health trajectories in adulthood set stage for later life—important
in aging societies

Social change due to economic development and Westernization
changes nature of adult life course and nature of health risks and
conditions
-  Increasing age at marriage
  Partly due to longer education
-  Declines in fertility
-  Differences in jobs
-  Differences in gender roles
16